#29 Intensity-Modulated Radiation Therapy: The State of the Art

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Medical Physics | December 2003

"Intensity modulated radiation therapy (IMRT) represents a new paradigm for planning and
delivering external beam radiation therapy. The techniques of IMRT and the issues related to its
safe and efficacious clinical application have been the subjects of active research and are still
evolving (yearly peer-reviewed publications were over 200 in 2002 as compared to about 10 in
1995). Meanwhile, lured by its potential of further improving the therapeutic ratio and, to some
extent, by the pressure of marketing, IMRT is being introduced rapidly into many clinics. The
high demand in clinical implementation, which is at a time when many of its technical and
clinical issues are being investigated and standardized, has created an urgent need in educating
the physics and medical communities on the basic process of IMRT and the pitfalls in its
implementation. It is timely that the American Association of Physicists in Medicine (AAPM)
devoted the 2003 summer school to IMRT. Intensity-Modulated Radiation Therapy-The State of
the Art is published as the proceedings of this five-day comprehensive summer school.

"The proceedings contains 35 chapters, covering almost all relevant topics of IMRT. Beginning
with a chapter on the historical perspectives of IMRT, the remaining chapters cover many of the
pertinent issues regarding IMRT. These include mathematical optimization, physical
optimization, biological indices for evaluation and optimization, aperture based inverse planning,
medical imaging in IMRT planning, target and critical structure definitions, dose prescriptions
and reporting. Major techniques used in delivering an IMRT treatment were discussed
individually in separate chapters, along with discussions on radiation shielding, dosimetry, and
misconceptions in IMRT. Later chapters deal with the commissioning and quality assurance
issues relating to the IMRT implementation as well as to the patient-specific planning and
treatment delivery, MU calculations, and Monte Carlo calculations for IMRT. Also included are
discussions on site specific treatments for the prostate, head and neck, and lung including
respiratory motion. In the last four chapters, discussions are presented on electron and proton
IMRT as well as the socioeconomic issues and the future perspectives on IMRT.

"The chapters are written by the faculty members of the summer school who are active research
investigators in IMRT. Each chapter is well written, with a good balance of scope and depth on
the subjects. They also provide a comprehensive list of references to the original work, which is
very useful to those readers who would like to further pursue certain subjects. Readers who are
interested in particular topics may go directly to the relevant chapters because each chapter could
be read almost independently. The quality of the book far exceeds most published proceedings.
All chapters are printed in the same textbook-quality typesetting and are easy to read. A CD
ROM which comes with the book contains the chapters in the Adobe pdf format. It is easier to
carry around compared to the 888-page book.

"The book has succeeded in providing a comprehensive overview of the current state of the art of
IMRT. It is a good resource for physicists who are about to implement an IMRT program in their
clinics. For physicists who have established a clinical IMRT program, the book serves as a timely
update on many important issues concerning the safe and efficacious use of IMRT. Even for
physicists who are engaged in active research on IMRT, the snapshot captured by the book on the
current state of IMRT may help to promote a broader perspective on many issues and topics to be
investigated. I highly recommend the book to all medical physicists in radiation therapy."

-reviewed by Zhe Chen

Zhe Chen, Ph.D., is an associate clinical professor in the Department of Therapeutic Radiology
at Yale University School of Medicine. His research interests include basic radiation dosimety,
treatment plan optimization, and clinical applications of radiobiological modeling.